. 06670220-1021USLNY Self-Accounting Premium Statement Supplmental/Step Rated NY
. 06670220-1022USLNY Self-Accounting Premium Statement NY
. 06670220-1023USLNY Self-Accounting Premium Statement for Voluntary Life, AD&D, Dependent Child NY
. 06670220-1026USLNY Self-Accounting Premium Statement for Voluntary STD & LTD NY
. 06670220-1183USLNY Master Application NY
Neptune-Administered Forms for New York
The below forms are specific to this state. Non-state specific forms can be located on the General Forms page. Please note that The United States Life Insurance Company in the City of New York is the only approved underwriting company for the State of New York.
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Administration
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Claims
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The United States Life Insurance Company
. 00304201-1079USLCANY Proof of Group Death Claim Form CA NY
. 06670220-1031USLNY Proof of Group Death Claim for Dependents of Employees Only NY
. 06670220-1033USLNY Proof of Group Death Claim NY
Group Statement of Insurability
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The United States Life Insurance Company
.06673571-1005USLNY Statement of Insurability for Group Programs NY
Voluntary Statement of Insurability
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The United States Life Insurance Company
.00305101-1098USLNY Application for Group Voluntary Programs NY